HomeMy WebLinkAboutPermit Renewal PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
- BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE RFCFI��o
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578 �v A s
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PERMIT RENEWAL REQUEST
PERMIT NUMBER: (J� ✓� ADDRESS: '�—1 3 js)�� yy CJS
I, nIJ zac,01<- ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
MNERIBLIN OR CONTRACTOR SIGNATURE DATE
I MA15 MUK
Print Name
STATE OF FLORID
COUNTY OF 5- �lf . e nd
ACKNOWLEDGED BEFORE ME THIS , /'��AY OF N)CWJh�,� ,20 I
BY E)Qn1 n►6 tXL0Qt WHO IS PERSONALLY KNOWN TO ME L,� ,OR
HAS PROVIDED AS IDENTIFICATION.
S OF FLORIDo f
COLEEN SULLIVAN
611A.K Xj A4 MY COMMISSION#GG071535
GNATURE OF 0 Y SEAL EXPIRES February 09,2021
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014